Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis

Abstract

Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.

Patient-Reported Functional and Satisfaction Outcomes after Robotic-Arm-Assisted Total Knee Arthroplasty: Early Results of a Prospective Multicenter Investigation

“…It has been demonstrated that RATKA is able to accurately and consistently achieve the desired implant placement and alignment. [13][14][15] However, there is a paucity of prospective studies demonstrating that the functional outcomes achieved using robotic technology are superior to manual techniques in terms of patient satisfaction and functional abilities. Therefore, the purpose of this study was to assess short-term patient satisfaction and functional outcomes in robotic-assisted versus manual TKA patients.…”

“…It has been demonstrated that robotic-arm-assisted TKA (RATKA) is able to accurately and consistently achieve the desired implant placement and alignment. [13][14][15] Although bone cuts and implant placement accuracy and precision are important for long-term implant survivorship, [16][17][18][19] there is a paucity of prospective studies comparing the outcomes achieved using robotic technology versus manual techniques in terms of patient satisfaction and functional abilities. One recent retrospective study has demonstrated significantly lower pain scores and higher satisfaction indices in patients who underwent RATKA, when compared with manual TKA.…”

New and evolving technologies for knee arthroplasty—computer navigation and robotics: state of the art

“…In a meta-analysis of seven studies and three registries, van der List et al 28 reported the difference in the annual revision rate (ARR) of computer navigation versus conventional TKA surgery in 4 70 231 patients. Analysis showed an ARR of 0.55 in patients who underwent computer-navigated TKA surgery and an ARR of 0.56 in patients who underwent conventional TKA surgery (P=0.58).…”

Unicompartmental knee arthroplasty: state of the art

“…The Stryker/MAKO haptic guided robot (MAKO Surgical Corp) has the largest market share with 20% for UKA. Since the introduction in 2005, over 50 000 have been performed with nearly 300 robotic systems nationally 33 80 84…”

“…These advances will be implemented by means of simplifying the process and minimises the learning curve. Critical domains will possibly include preoperative analysis, intraoperative sensors and robotically controlled instrumentation 84. Currently, some sort of imaging modality is necessary in order to perform preoperative planning, depending on the type of robotic system.…”